Domains Of School Functioning Research Articles

Analyzing the Quality of Life in Individuals with Fragile X Syndrome in Relation to Sleep and Mental Health.

The purpose of this paper was to examine the physical, emotional, social and school functioning domains of quality of life of individuals with Fragile X Syndrome, in relation to mental health and sleep patterns to gain a better understanding of how these aspects are affected by the disorder. This study included 119 individuals with Fragile X Syndrome who were given different cognitive examinations by a neuropsychologist or by parent-proxy questionnaires. This study focused on the Pediatric Quality of Life Inventory (PedsQoL), the Anxiety, Depression and Mood Scale (ADAMS), the Children's Sleep Habits Questionnaire (CSHQ), but did include other cognitive tests (Vineland Adaptive Behaviour Scales, Nonverbal IQ, Autism Diagnostic Observation Schedule). We identified significant associations between decreases in emotional, social and school domains of PedsQoL and the ADAMS subtests of Generalized Anxiety, Manic/Hyperactivity and Obsessive/Compulsivity, with the subtest of Depressed Mood having associations with lower physical and emotional domains. We also identified a significant impact between CSHQ subtests of Sleep Anxiety, Night Wakings, Daytime Sleepiness, and Parasomnia with the emotional and school domains of PedsQoL. There were associations connecting school functioning with Bedtime Resistance, and additional associations connecting emotional functioning with Sleep Duration and Sleep Onset Delay. Physical functioning was also associated with Sleep Anxiety. Our study shows how mental health and sleep defects impact improper sleep patterns and mental health which leads to decreases in the quality of life for individuals with FXS, and how it is important to screen for these symptoms in order to alleviate issues.

Walking capacity and its association with quality of life among children with down syndrome in Saudi Arabia

BackgroundWalking ability, which has been connected to better health and independence, is one of the daily activities that is negatively impacted by Down syndrome. Thus, the objective of this study was to examine the walking capacity and its association with the quality of life of children who have Down syndrome compared to those who do not have Down syndrome in Saudi Arabia.MethodsFor this cross-sectional study, we recruited 68 Arabic-speaking children aged 6 to 12 using a convenience sampling method from August to November 2021. Children were divided into two groups: those who do not have Down syndrome (n = 38) and those who have Down syndrome (n = 30). Children in the Riyadh region of Saudi Arabia who do not have Down syndrome were chosen randomly from two schools. Children who have Down syndrome were selected from multiple associations and centers in the same region. A 6-minute walk test was used to measure the child’s walking capacity. The Arabic version of the Pediatric Quality of Life Inventory scale was used to assess the child’s or parent’s perceptions of the child’s quality of life and its physical, emotional, social, and school functioning domains.ResultsThe difference in the mean 6-minute walk test scores between children who have and who do not have Down syndrome was statistically significant, with a mean difference = 105.6, 95% confidence limit = 57.2—154.0, p < .0001. The linear regression analysis after adjusting for age, height, weight, and body mass index revealed that walking capacity was found to be significantly associated with the worst score on the Pediatric Quality of Life Inventory scale (β = −2.71, SE = 0.49, p < .0001) and its domains of physical, social, and school functioning (β = −2.29, SE = 0.54, p < .0001; β = −2.40, SE = 0.58; p = .001; β = −3.71, SE = 0.56, p = .002, respectively) in children who have Down syndrome, but they had better emotional functioning than children who do not have Down syndrome.ConclusionsChildren who have Down syndrome were less able to walk and were highly associated with the worst possible quality of life, which included the lowest levels of physical, social, and school functioning. Early interventions with techniques must be developed to improve the quality of life for these children.

Assessment of quality of life and physical activity in patients with oligoarticular juvenile idiopathic arthritis in remission.

The purpose of this study was to evaluate physical activity (PA) and health-related quality of life (HRQOL) in children with oligoarticular juvenile idiopathic arthritis (JIA) in remission in comparison with healthy peers and to determine the disease-related factors affecting PA levels. This study was conducted with 50 oligoarticular JIA patients in remission and 50 healthy peers between 9 and 14years. Demographic and clinical characteristics, laboratory parameters, and treatments were noted from electronic medical records. HRQOL was assessed with the Pediatric Quality of Life Inventory (PedsQL). PA was evaluated with the Physical Activity Questionnaire for Children (PAQ-C). Oligoarticular JIA patients had significantly lower self-reported median PedsQL scores in the domains of school functioning and social functioning compared to the control group (67.5 (10) vs. 75 (25), p = 0.001 and 70 (15) vs. 85 (26.3), p < 0.001, respectively). The median PAQ-C score was 2.6 (1.1) in patients with JIA and 3 (0.9) in their healthy peers (p = 0.02). The PAQ-C score was 2.8 (1.2) in patients < 8years at the disease onset and 2.3 (1) in those aged ≥ 8years (p = 0.022). There was no significant difference in the number of affected joints, type of affected joint, MTX and biologic agent treatment, and remission with or without drugs with the total score of the PedsQL and PAQ-C. All PedsQL domains were positively correlated with the PAQ-C. Conclusion: Oligoarticular JIA patients demonstrated lower PA and HRQOL scores compared to healthy controls despite favorable disease control. What is Known: • Oligoarticular JIA has fewer functional limitations and disabilities compared to other JIA subtypes. • As JIA can affect all aspects of a child's life, there is a need to improve the quality of life related to the disease. What is New: • It should be considered that patients with oligoarticular JIA may show lower PA and HRQOL scores compared to healthy controls despite favorable disease control. • Since there may be a relationship between PA and HRQOL, factors that may affect PA should be investigated to provide a holistic approach to JIA treatment.

Cross-sectional and prospective associations between children's 24-h time use and their health-related quality of life: a compositional isotemporal substitution approach

Promoting active, balanced lifestyles among children may be an important approach to optimising their health-related quality of life (HRQoL). However, the relationships between children's movement behaviours and HRQoL remain unclear. We examined the associations between movement behaviours (sleep, inactivity, light and moderate-to-vigorous intensity physical activity) assessed using accelerometers at ages 8 and 10 years and self-reported HRQoL scores (overall, and physical and emotional well-being, self-esteem, relationship with family and friends, and school functioning domains) at age 10 years among 370 children in a local birth cohort using compositional isotemporal substitution techniques. Cross-sectionally, light and moderate-to-vigorous intensity physical activities were associated with better self-esteem (β=15.94 [2.71, 29.18]) and relationship with friends (β=10.28 [3.81, 16.74]) scores respectively. Prospectively, inactivity was associated with lower overall HRQoL (β=-10.00 [-19.13,-0.87]), relationship with friends (β=-16.41 [-31.60,-1.23]) and school functioning (β=-15.30 [-29.16,-1.44]) scores, while sleep showed a positive trend with overall HRQoL (β=10.76 [-1.09, 22.61]) and school functioning (β=17.12 [-0.87, 35.10]) scores. Children's movement behaviours were not associated with their physical and emotional well-being, or relationship with family scores. The isotemporal substitution analyses suggest that increasing time spent in physical activity and/or sleep at the expense of inactivity may benefit children's HRQoL. Our findings suggest that sleep and physical activity may be associated with better HRQoL, with the inverse for inactivity. However, the relationship between children's movement behaviours and HRQoL is complex and warrants further research. Singapore National Research Foundation, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research.

Analysis of Social Mission Commitment at Dental, Medical, and Nursing Schools in the US

The COVID-19 pandemic and calls for racial justice have highlighted the need for schools to promote social mission. Measuring social mission engagement and performance in health professions education may encourage institutional efforts to advance health equity and social justice commitments. To describe the current state of social mission commitment within dental, medical, and nursing schools in the US and to examine how social mission performance compares across school types. This cross-sectional survey study invited all US dental and medical schools and a subset of baccalaureate- and master's degree-conferring nursing schools to participate in a self-assessment to measure their school's social mission commitment from January 29 through October 9, 2019. The survey measured 79 indicators (with indicators defined as responses to specific scored questions that indicated the state or level of social mission commitment) across 18 areas in 6 domains of school functioning (educational program, community engagement, governance, diversity and inclusion, institutional culture and climate, and research) that have potential to enhance social mission engagement and performance. Individual health professions schools were the unit of analysis, and 689 dental, medical, and nursing schools were invited to participate. School deans and program directors were the primary target respondents because of their broad insight into their school's programs and policies and their ability to request data from various internal sources. Demographic information from respondents was not collected because multiple respondents from an institution could complete different sections of the survey. Survey responses were analyzed to create indicator scores, standardized area scores, and an overall social mission score for each school. Using descriptive analyses, frequency and contingency tables of specific indicators within each area were created, and schools were compared based on ownership status (private or public), Carnegie Classification of Institutions of Higher Education research classification group (doctoral university with very high research activity [R1], doctoral university with high [R2] or moderate [R3] research activity, baccalaureate or master's nursing college or university, or special focus institution), and discipline group (dental school, medical school granting doctor of osteopathic medicine [DO] degrees, medical school granting doctor of medicine [MD] degrees, nursing school granting baccalaureate-level degrees, or nursing school granting master's-level degrees). Among 689 invited schools, 242 schools (35.1%) completed the self-assessment survey. Of those, 133 (55.0%) were nursing schools, 83 (34.3%) were medical schools, and 26 (10.7%) were dental schools. Response rates ranged from 133 of 420 invited nursing schools (31.7%) to 83 of 203 invited medical schools (40.9%). Most schools included social determinants of health in their curriculum in either required courses (233 of 242 schools [96.3%]) or elective courses (4 of 242 schools [1.7%]), but only 116 of 235 schools (49.4%) integrated social determinants of health across all years of study. Most schools also included health disparities in either their required courses (232 of 242 [95.9%]) or elective courses (6 of 242 [2.5%]); however, only 118 of 235 schools (50.2%) integrated health disparities across all years of study. In several areas of social mission, public schools performed better than private schools (eg, curriculum: mean [SE] standardized area score, 0.13 [0.07] points vs -0.14 [0.09] points, respectively), and R1 doctoral universities and special focus institutions performed better than R2 and R3 doctoral universities and baccalaureate and master's nursing colleges and universities (eg, extracurricular activities: mean [SE] standardized area score, 0.25 [0.09] points for R1 doctoral universities and 0.20 [0.12] points for special focus institutions vs -0.05 [0.12] points for R2 and R3 doctoral universities and - 0.30 [0.12] points for baccalaureate and master's nursing colleges and universities. Different areas of strength emerged for dental, medical, and nursing schools. For example, in the curriculum area, MD-granting medical schools had a mean (SE) standardized area score of 0.38 (0.08) points, which was significantly higher than the standardized area scores of dental schools (mean [SE], -0.21 [0.14] points), DO-granting medical schools (mean [SE], -0.22 [0.13] points), graduate nursing schools (mean [SE], -0.21 [0.19] points), and undergraduate nursing schools (mean [SE], -0.05 [0.10] points). In this study, there was widespread interest from health professions educational leaders in understanding and enhancing social mission commitment. Future work may focus on identifying and promoting best practices using the framework described, providing schools with continued opportunities for self-assessment, and further validating the self-assessment survey.

An assessment of the construct validity of the Child Health Utility 9D-CHN instrument in school-aged children: evidence from a Chinese trial

BackgroundAlthough there is emerging data regarding the psychometric properties of the Child Health Utility-9D instrument, more evidence is required with respect to its validity for use in different country settings. The aim of this study was to examine the construct validity of the CHU-9D-CHN instrument in Chinese children.MethodsBaseline Health-Related Quality of Life (HRQoL) and demographic data were collected from children recruited to the CHIRPY DRAGON obesity prevention intervention randomised controlled trial in China. HRQoL was measured using the Chinese version of the CHU-9D instrument (CHU-9D-CHN) and the PedsQL instrument. CHU-9D-CHN utility scores were generated using two scoring algorithms [UK and Chinese tariffs]. Discriminant validity, known-group validity and convergent validity were evaluated using non-parametric test for trend, Kruskal–Wallis test and Spearman correlation coefficient analysis respectively.ResultsData was available for 1,539 children (mean age 6 years). The CHU-9D-CHN was sensitive to known group differences determined by the median PedsQL total score. Furthermore, the mean CHU-9D-CHN utility values decreased linearly with increasing levels of severity on each dimension of the PedsQL for emotional and social functioning domains. They decreased monotonically with increasing levels of severity on each dimension of the PedsQL for physical and school functioning domains (p < 0.001). Contrary to studies conducted in Western countries, and although not statistically significant, we found an indication that HRQoL, using both the CHU-9D-CHN and the PedsQL, was higher in children whose parents had lower levels of education, compared to those whose parents were university educated. The correlation between the CHU-9D-CHN utility values using UK and Chinese tariffs, and PedsQL total scores showed a statistically significant moderate positive correlation (Spearman’s rho = 0.5221, p < 0.001 and Spearman’s rho = 0.5316, p < 0.001), respectively. However, each CHU-9D-CHN dimension was either weakly, or very weakly correlated with each of the predetermined PedsQL domain functioning scores.ConclusionsOverall, the findings provide some support for the construct validity of the CHU-9D-CHN within a Chinese population aged 6–7 years. However, some uncertainty remains. We recommend future studies continue to test the validity of the CHU-9D in different country settings.Trial registration: ISRCTN Identifier ISRCTN11867516, Registered on 19/08/2015

Impact of executive functioning on health-related quality of life of pediatric brain tumor survivors.

Brain tumor survivors are at risk for significant late effects following treatment completion that may adversely impact health-related quality of life (HRQOL). The current study examines the relationship between executive functioning (EF) and HRQOL in pediatric brain tumor survivors within a longitudinal framework. We hypothesized that early deficits in EF would be related to less optimal HRQOL in this population. The current study utilized retrospective medical chart review to identify neurocognitive correlates of HRQOL in 137 youth previously treated for a pediatric brain tumor. Participants completed the Pediatric Quality of Life Inventory (PedsQL) and neuropsychological assessment, including a well-validated measure of executive functioning (Behavior Rating Inventory of Executive Function; BRIEF). General linear regression and multivariate models were utilized to examine the relationship between child executive functioning and HRQOL. Multiple domains of child executive functioning, as reported by parents on the BRIEF, significantly predicted parent-proxy reported HRQOL after controlling for demographic and medical covariates, including child intellectual functioning (IF). Similarly, after controlling for covariates, the BRIEF Cognitive Regulation Index was a significant predictor of self-reported physical and school functioning domains of HRQOL. Current data demonstrate EF is a significant predictor of HRQOL during survivorship for youth previously diagnosed with a pediatric brain tumor. Results suggest that opportunities may exist to intervene and improve HRQOL of pediatric brain tumor survivors by targeting EF.

Clinical Outcome, Cognitive Function, and Quality of Life after Endoscopic Third Ventriculostomy versus Ventriculo-Peritoneal Shunt in Non-Tumor Hydrocephalus.

Endoscopic Third Ventriculostomy (ETV) is increasingly being accepted as the treatment of choice in place of Ventriculo-Peritoneal (VP) Shunt for hydrocephalus. However, their differences in cognitive and Quality of Life (QOL) scores have not been studied much in children. To compare the outcome, cognitive function, and QOL between ETV and VP shunt. Patients of non-tumor hydrocephalus treated with ETV or/and VP shunt underwent cognitive assessment (using modified child MMSE standardized as per the age group) and QOL (using PedsQL as per the age group in Physical, Emotional, Social, and School Functioning domains) in addition to the outcome of not requiring additional intervention. Out of 139 patients, there were 29 infants and 40 children upto 14 years. Among these children, ETV was the primary intervention in 45, VP shunt in 24, and could be studied for a mean follow-up of 1.7 years. Though ETV required lesser additional intervention than VP shunt (19.2% vs. 28.6%) in toddlers and older children, there was no overall significant difference. Subnormal cognitive scores were noted in 25%, 40%, and 50% after ETV, single shunt procedure, and multiple shunt procedures, respectively, with no statistically significant difference. Among the different domains of QOL, the child reported scores in the social domain were significantly better after ETV than VP shunt (475[+13] vs. 387[+43], P value 0.03), whereas most other scores were non-significantly better following ETV. Patients who underwent ETV show a trend for better clinical outcome, cognitive function, and QOL with significantly better child-reported QOL scores in the social domain.

Associations Between Participation in After-School Activities, Attention-Deficit/Hyperactivity Disorder Severity, and School Functioning.

To examine the association between after-school activity (ASA) participation, attention-deficit/hyperactivity disorder (ADHD) severity, and school functioning among children with ADHD. A cross-sectional study was conducted using data from the 2016 National Survey of Children's Health on ADHD severity, ASAs and 2 domains of school functioning among children with ADHD: missed days from school and calls home from school. Of 4,049 children with ADHD (weighted N = 5,010,662), 71.8% participated in at least 1 ASA. In multivariable regression analyses, ASA participation was associated with lower odds of moderate-to-severe ADHD [adjusted odds ratio (aOR): 0.62, 95% confidence interval (CI), 0.46-0.85] and lower odds of missed school days (aOR 0.55, 95% CI, 0.41-0.74). We did not find significant associations with calls home from school (aOR 0.79, 95% CI, 0.59-1.07). After-school activity participation is associated with decreased ADHD severity and reduced school absenteeism. Efforts to optimize ADHD outcomes should consider engaging children and adolescents in ASAs.

PedsQL Score Post Encephalo-duro-arterio-myo-synangiosis Procedure for Moyamoya Disease: A Single Center Experience

Moyamoya disease is a progressive, occlusive arteriopathy of the intracranial vessels causing an increased risk of stroke. It often results in functional impairment and decrease in quality of life, both in the presence and absence of stroke. Revascularization is the accepted treatment for patients with symptomatic moyamoya disease, preventing further stroke. At Leeds Children's Hospital we use the encephalo-duro-arterio-myo-synangiosis (EDAMS) technique to facilitate revascularization. We aim to assess the quality of life outcomes of patients who have undergone operative intervention at our unit for moyamoya disease. Pediatric patients with operated moyamoya disease from Leeds Children Hospital between February 2009 and January 2019 were included. Patients awaiting primary surgery were excluded. Patients were contacted via telephone and the Pediatric Quality of Life Inventory 4.0 (PedsQL) questionnaire administered via parent proxy. Quality of life outcomes were assessed using the PedsQL questionnaire score, which measures physical, emotional social and school functioning domains. This score was then converted to a health-related quality of life score. Scores in each domain and mean scores were compared with normative data. This study included 11 children (5 boys), median age 6.8 years (range: 22 months to 15.5 years), and 9 children underwent bilateral operations. Mean parent proxy PedsQL score was 66 (range: 12.5-98.4), with a mean score of 61.9 in physical function, 88.9 in emotional function, 70.9 in social function, and 58.7 in school function. This was lower than healthy controls overall and in each individual domain except emotional function, which was similar to normative data. Children with moyamoya disease have a lower quality of life than healthy controls within this series. This suggests that children with moyamoya should be offered additional psychosocial support within the community.

Quality of life in children with thalassemia major following up at a tertiary care center in India (GOTQoL)

Background: This study aims to measure the quality of life (QoL) scores in children with thalassemia major following up at a tertiary care center for routine blood transfusion in comparison to healthy children.Methods: A case control study design was adopted, wherein on the QoL of 36 children with thalassemia in the age group 5 to 18 following up for blood transfusion at Goa Medical College, was measured using PedsQL™ 4.0. This was compared to the QoL in age and gender matched healthy children from a government school. A higher score on a subscale indicates better quality of life on this instrument.Results: The children with thalassemia had lower mean scores on physical (67.85 vs 84.24; P &lt;0.001), social (78.34 vs 87.95; P=0.002) and school (62.64 vs 79.48; P &lt;0.001) functioning subscales compared to the healthy children. They also had lower mean psychosocial summary score (73.32 vs 82.01; P=0.003) and total health summary score (71.95 vs 82.57; P &lt;0.001). The physical functioning subscale had significantly higher score among the children who were on chelation and also among the ones whose parents reported as being informed about the condition.Conclusions: The children with thalassemia have poor QoL in physical, social and school functioning domains. Improvement in QoL requires consolidated efforts on part of doctors, parents, school authorities and policy makers. These patients should be provided with low cost-effective chelation therapy. The parents need to be counselled about this disease by the treating team.

Child Maltreatment, School Bonds, and Adult Violence: A Serial Mediation Model.

Physically abused youth are vulnerable to experiencing difficulties across multiple domains of school functioning. Most of the literature examining the relationship between child physical abuse (CPA) and adult violence has focused narrowly on academic outcomes rather than taking a broader view that explores the processes undergirding school engagement and connections. The present study adopted Connell's model of school engagement, connectedness and outcomes within a social bond framework to examine (a) the link between CPA and school social bonds, (b) the link between CPA and adult violence persistence, and (c) the mediational (parallel, serial) effects of school bonds (engagement, connection, and achievement) on violence perpetration in adulthood. Consistent with previous research, results indicated that children who experience physical abuse have poorer academic performance, which, in turn, is related to future violent trajectories. We further found that the relationship between CPA and violence persistence is mediated by a process of bonding to school that begins with being actively engaged in school activities and ends with higher levels of academic achievement. In particular, some of the "school achievement" effect found in previous research operates through behavioral and emotional manifestations and may be partly explained through physically abused children's lessened ability to be engaged with and connected to school activities. We conclude with a discussion of the policy implications stemming from our findings.

PND127 - QUALITY OF LIFE IN PAEDIATRIC MULTIPLE SCLEROSIS: SYSTEMATIC LITERATURE REVIEW

Although multiple sclerosis (MS) is typically diagnosed in adulthood, European studies report up to 20% of cases having paediatric onset (defined here as age ≤18 at study entry). This systematic review identified studies reporting health-related quality of life (HRQoL) or utilities in paediatric MS. MEDLINE, Embase, the Heath Technology Assessment (HTA) Database and NHS Economic Evaluation Database were queried 15 February 18, and EconLit on 8 February 18. Key conferences, UK HTAs, and included publications' bibliographies were hand-searched. Searches encompassed UK economic evaluations, UK costs and resource use, utilities and HRQoL, but the focus here is on utilities and HRQoL data reported for the paediatric population and their caregivers. Of 3,839 records retrieved, none reported utilities and nine HRQoL in paediatric MS. Six used the PedsQL instrument (scale 0-100; worst-best HRQoL), with four reporting mean scores. For physical, emotional, social, and school functioning domains, these scores were 74.8–83.6, 56.3–77.2, 76.3–93.1 and 63.6–83.1, respectively. Comparing self- and parent-proxy-reported HRQoL with any instrument revealed mixed findings; in 3/7 studies, more self-reported than parent-reported outcomes were poorer, in 1/7 the reverse was true, and in 3/7 counts were equivalent. 3/3 studies comparing paediatric MS HRQoL with healthy control data found this was significantly poorer in the former in domains including physical, emotional and academic functioning. 1/1 studies reporting parent HRQoL (n=15) found no significant difference to scores from parents of children without MS (n=29). No studies compared HRQoL between adults and children with MS. No utility studies in paediatric MS were identified. However, in this small evidence base, a HRQoL burden appears evident, with average domain scores suggesting a particular impact on emotional functioning. Interventions may affect HRQoL, however heterogeneity between studies limits an assessment of this.

Cumulative effects of multiple pain sites in youth with chronic pain.

The experience of persistent pain in multiple locations is common in youth. Based on current literature, youth with multiple pain sites (MPS) are at risk of experiencing poorer emotional outcomes and a spread of symptoms into late adolescence and adulthood. Little is known regarding the association between MPS with physical and school functioning domains, particularly after initiation of multidisciplinary pain treatment. Therefore, the objective of this study was to examine the association of MPS with disability and school functioning among youth with chronic pain. A total of 195 patients with chronic pain, aged 8-17, and their parents completed measures assessing patient distress and functioning at a multidisciplinary pain clinic evaluation and at 4-month follow-up. At evaluation, 63% of patients presented with MPS; 25% reporting MPS endorsed pain in five or more locations. When controlling for relevant demographic and emotional distress factors, MPS were associated with lower school functioning at evaluation with a persistent trend at follow-up. Although MPS were not a significant predictor of pain-related disability at evaluation, it emerged as significant at follow-up. Potentially due to the MPS load and the inverse effects that such a pain state has on function, such patients may be at risk for poorer health and school-related outcomes. The mechanisms influencing these relationships appear to extend beyond psychological/emotional factors and warrant further investigation in order to aid in our understanding of youth with MPS. Youth with MPS may be at risk for experiencing poorer physical and school functioning in comparison with single-site peers, despite treatment initiation. Further research is warranted to inform assessment and treatment approaches for this subgroup of patients.

Quality of Life of Obese School-Age Children and their Mothers' Perspectives in Cairo, Egypt

Background: Obesity is rapidly overtaking as a burden of the disease, it is expanding to include children, which put it on the top of the international public health agenda. Aim the study aimed to explore the quality of life among school-age children suffering from obesity and their mothers’ perspective in the Cairo governorate. Research design was descriptive correlational cross-sectional design. Setting: The study was carried out in selected governmental primary schools in Cairo governorate. Sample: In total, two hundred children and their mothers agreed to participate in the study. Tools: Two tools were used, I : Pre-designed Questionnaire interviewing Format which consisted of three parts: first part focused on socio-demographic data for children such as age, gender, grade level, their parents’ educational levels and family income of the studied sample. Second part focused on medical and family history. Third part focused on the nutritional habits of children. II: Pediatric Quality of Life Inventory version 4.0 which consisted of two part, first part: Children health-related quality of life to assess QoL of children which includes 3-items covering the physical, emotional, social and school functioning domains. Second part: Mothers’ perspective on the QoL of their children. Results: that the mean age of the participating school children was ૛.37 ± 1.8, ⯀3.5% of the children were obese and 5% of them had obesity class III. ⯀૛.5% of children have a positive family history of obesity. An overview of the QoL dimensions, showing the weighted means for physical, social, emotional, and school dimensions (1.૛⯀±0.43; 1.૛4±0.51; 1.⯀5±0.3૛; 1.80±0.43 respectively). These values indicate poor QoL. Conclusion: It was concluded that school-age children in the Cairo governorate had a poor QoL, with a statistically significant difference recorded with respect to age, BMI, and family income, and a highly statistically significant difference with the educational level of the mother of each child. However, no statistically significant difference was identified between QoL and gender. Recommendation: Establish education programs from school age onwards to teach families about healthy eating habits and raise awareness of health hazards associated with fast food consumption.

Influence of Disruptive Behavior Disorders on Academic Performance and School Functions of Youths with Attention-Deficit/Hyperactivity Disorder

Childhood attention-deficit/hyperactivity disorder (ADHD) and comorbid oppositional defiant disorder/conduct disorder (ODD/CD) are associated with negative school outcomes. The study aimed to examine the impact of ADHD and ODD/CD on various school functions. 395 youths with ADHD (244 with ADHD + ODD/CD and 151 with ADHD only) and 156 controls received semi-structured psychiatric interviews. School functions were assessed and compared between each group with a multiple-level model. The results showed that youths with ADHD had poorer performance across different domains of school functioning. Youths with ADHD + ODD/CD had more behavioral problems but similar academic performance than those with ADHD only. The multiple linear regression models revealed that ADHD impaired academic performance while ODD/CD aggravated behavioral problems. Our findings imply that comorbid ODD/CD may specifically contribute to social difficulties in youths with ADHD. Measures of early detection and intervention for ODD/CD should be conducted to prevent adverse outcomes.

Fecal Incontinence in Adolescents Is Associated With Child Abuse, Somatization, and Poor Health-related Quality of Life.

The aim of this study was to evaluate the association between fecal incontinence (FI), child abuse, somatization, and health-related quality of life (HRQoL) in adolescents. Adolescents (ages 13-18 years) were selected from 4 semi-urban schools in the Gampaha district, Sri Lanka. A validated, self-administered questionnaire was used for data collection. FI was defined as at least 1 episode of leakage of feces per month. A total of 1807 adolescents were analyzed (boys 973 [53.8%], mean age 14.4 years, standard deviation [SD] 1.4 years). A total of 47 (2.6%) had FI. Prevalence of sexual abuse (17% vs 2.3% in controls, P < 0.0001), emotional abuse (40.4% vs 22.7%, P < 0.0001), and physical abuse (51% vs 24.3%, P < 0.0001) was significantly higher in children with FI. Adolescents with FI had higher mean somatization scores [mean 20.1, (SD 14.5) vs mean 9.3, (SD 9.2)] compared with those without FI (P < 0.0001). Those with FI also had lower HRQoL scores for physical functioning, social functioning, emotional functioning domains, and performances at school, together with a lower overall HRQoL score compared with those without FI (74.6 vs 87.1, P < 0.0001). There is a significant association between FI and physical, sexual, and emotional abuse. They also have a higher somatization score and a poor HRQoL score in physical, emotional, social, and school functioning domains compared with those without FI.

Conceptions and perceptions of student initiative held by elementary school teachers and students

The aim of this study is to provide empirical analysis of teachers' and students' understanding of the term student initiative and their perceptions of its manifestations in school environment. A total of 182 teachers and 223 8th grade students were asked to (1) provide associations to the term 'initiative', (2) to specify personal characteristics and behaviors of students with high initiative and (3) to report on the importance and levels of student initiative manifested in different domains of school functioning. Both teachers' and students' associative fields for the term initiative are extremely large and with weak associative strength, implying various diverse meanings. However, both groups consider student initiative as an important feature for school functioning and report on student initiative being manifested in different domains of school life. While there are some differences, both groups connect student initiative with success in school but not with the gender of the student, pointing out prosocial behavior in the school environment and dedication to learning, as well as readiness for additional engagement in the class. Implications for school practice are discussed in terms of changing teacher - student patterns of conversational activities and inclusion of complex and challenging tasks connected to learning material.

Transmission of Work Ethic in African-American Families and Its Links with Adolescent Adjustment.

A strong work ethic generally has positive implications for achievements in work and school settings, but we know little about how it develops. This study aimed to describe the intra-familial transmission of work ethic and the associations between work ethic and adjustment in African American youth. Mothers, fathers, and two adolescent siblings (M age=14.1years) in 158 families were interviewed on two occasions. Path models revealed that fathers' work ethic was positively linked with older siblings' work ethic, which in turn was linked with more positive youth adjustment in the domains of school functioning and externalizing and internalizing problems. Moreover, the results indicated that the work ethics of older siblings, but not parents, was linked to those of younger siblings. The discussion focuses on the importance of African American fathers and siblings in youth adjustment and how work ethic may promote positive development.

Severity of pediatric pain in relation to school-related functioning and teacher support: An epidemiological study among school-aged children and adolescents

The current cross-sectional study examined child and adolescent pain severity in relation to various domains of school functioning and, in line with self-determination theory, the potentially protective role of perceived teacher support of child/adolescent autonomy and competence. Data from a large representative sample of Flemish school children and adolescents (N=10650; 50.8% boys; age range 10–21years; mean age=14.33) was collected as part of the World Health Organization (WHO) collaborative Health Behaviour in School-Aged Children (HBSC) survey. Child/adolescent pain severity was graded based on a pediatric pain classification system adapted from that of Von Korff et al. The current study thus provided insight regarding the prevalence of pain among Flemish children/adolescents and, extending the limitations of existing literature, examined the specific role of pain severity across various domains of school functioning. Findings indicated that a sizeable proportion of children reported moderate to severe pain problems (ie, about 14% of children and adolescents were classified in the highest pain grades: ie, grade III or IV). Furthermore, higher pain grades were associated with poorer outcomes across all indices of school functioning (ie, school absenteeism, school-related pressure and satisfaction, and bullying experiences), with the exception of academic performance. However, the association between pain grade and school absenteeism was less pronounced when children perceived their teachers to be highly supportive of competence and autonomy. Furthermore, teacher support of competence appeared to buffer against the harmful effects of severe pain upon instances of bullying experiences at school. Future research directions and implications for school-based interventions are discussed.